​As most administrators know, every day in a skilled nursing care center comes with its own, and sometimes unexpected, set of problems. However, many of the problems are recurring, and often the solutions put in place are Band-Aids that only temporarily solve the problem. Even though working in the long term/post-acute care (LT/PAC) profession can be rewarding, it can also become discouraging with the frustration of dealing with the same challenges over and over again.
After reading an article in Provider about Pioneer Network in 2004, the leadership staff at Haven Nursing Center in Columbia, La., felt a connection with its vision—a culture of aging that is life-affirming, satisfying, human, and meaningful—and its values. Everyone became inspired about ideas that held the promise of transforming the culture of Haven and its community.
Drawing inspiration from attending the 2004 Pioneer Network Conference, the staff immediately focused on transforming the center to achieve true organizational culture change and conquer the longstanding, day-to-day challenges. From that point forward, the staff knew that the status quo would never suffice for the organization. The opportunity was clear: to step outside the box and envision something greater than what staff had thought it could be.
Leadership staff committed themselves to the task of creating a workplace for employees that was uplifting and satisfying. They were determined to build a center with residents that would be life-affirming, satisfying, humane, and meaningful.
Person-directed care, staff empowerment, and eventually, changes in environmental design were the core elements of all the changes at Haven Nursing Center. When pursuing culture change, there is often a temptation to quickly incorporate tangible, visual changes to a center’s routines and services such as upgrading spas or switching to buffet dining. However, these items in and of themselves do not truly constitute a change in organizational culture. True organizational culture change comes at a much deeper, systemic level. It takes more thought, and it requires time.

On a Budget

Fortunately, the staff at Haven did not have the funding to begin with large environmental changes. This was fortunate because it forced everyone into doing the things that the center could afford, which included a deep dive into how decisions were made, how the organizational chart was structured, how management communicated with the team and regarded staff, and how residents were honored.
The changes instituted at this level became the underlying foundation for larger changes that came later. Over time the team removed all restraints without relying on bed alarms; moved to regular, nontherapeutic diets for all residents; discarded all dining trays; liberalized medication passes; established a practice of consistent assignment and self-scheduling; and adjusted time-off policies for staff.
Each change built on the one before, creating enthusiasm for additional improvement. Now, 13 years later, staff are thrilled to have renovated the older nursing center into the household model, with four separate and discrete households each with its own residential-style kitchen, dining, and living area.
At every point of the journey managers were constrained by a tight budget, but the imagination and commitment of the staff have never faltered. The Band-Aid approach has been replaced by a change in organizational culture that honors those who live and work within the nursing center.

The Efficacy of Person-Directed Care

There are some that look at the bottom-line and claim that these ideas will not improve cash flow. However, these actions have been the key to financial survival and improved quality of care. Occupancy is up, the Centers for Medicare & Medicaid Services Five Star Ratings are up, survey results are improved, community and volunteer support is improved, and staff turnover is down. 
KaraLe Causey, is board chair of Pioneer Network and chief operating officer/chief financial officer at Haven Nursing Center, Columbia, La. She can be reached at: Karale.causey@havennursingcenter.com.